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88-837 BUILDING PERMIT TOWN OF QUEENSBURY No. 88-837 WARREN COUNTY, NEW YORK a PERMISSION is hereby granted to Enoch Zylowski OWNER of property located at Bay Parkway, Assembly Point Street, Road or Ave. u in the Town of Queensbury,To Construct or place a Sewage Alteration at the above location in accordance to application together with plot plans and other information hereto filed and approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. 1. OWNER'S Address is Box 1262 Lake George, New York 12845 N 2. CONTRACTOR or BUILDER'S Name I-'i O SAME x r 3. CONTRACTOR or BUILDER'S Address O - - n 4. ARCHITECT'S Name 5. ARCHITECT'S Address tz w w n 6. TYPE of Construction—(Please indicate by X) ( )Wood Frame ( ) Masonry ( ) Steelca ( 1 ca In 7. PLANS and Specifications lEl NO 1000 gal tank as per plot plan, specification, and application. O 8. Proposed Use rt SEwage Alteration rr $ 35.00 PERMIT FEE PAID —THIS PERMIT EXPIRES DLV4 . October 25 1990 (If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the town of Queensbury before the expiration date.) (DD Dated at the Town of Queensbury 25th Day of October 19 88 rt (D n SIGNED BY for the Town of Queensbury N Building and oning Inspector 0 TOWN OF QUEENSBURY Y •,�Y� (J � APPLICATION FOR —� id SEPTIC DISPOSAL, PERK IT � �,. ko OCT 2L.. 1 DATE / E;� _L)iNG 8c C®DE DEF LOCATION OF PROPERTY FOR INSTALLATION _, y' Owner's Name: � ,�/ ��,a ���5'e_ / Telephone: 6.,_16 ���'�f✓ Address: <9Y � ��� L r� r �A 2,22 r Installer's Name: � �Uill, i'P� Telephone: ���V'—�8�%°� Number of bedrooms (residential only) Total daily flow (compute @ 150 gal per bedroom) Topography: circle one:16D Rolling Steep slope % of slope Soil Nature: circle one: Sand ' Loam Clay Other / Depth: feet — l Ground Water: At what depth? J feet Bedrock or Impervious Material: At what depth? feet Percolation test: circle one: not required required/rate min.inch. Domestic water supply: circle one: Municipal Well Other If domestic water supply is a Well: Separation: Watersupply from Septic absorption feet PROPOSED SYSTEM: Septic Tank LTQ 67 gal. (minimum size: 1,000 gal.) TILE FIELD: Each Trench feet / Total system length feet SEEPAGE PIT(S): Number of / Size each feet by' feet Size of stone to be used # /Depth or Thickness feet 9c�':icy'c�'c:c�'c'r:rk�e�c�:r:ex3e4c�'etc:c9e'c�c�'c9e3cie�'e9c�c:eke:e4c�Y:e4r��t*�c:c�cJ:�c3c'c�'c'�'e;l•'e I have read the regulation on the reverse side of this sheet and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewagd-.Disposal Ordinance. Signature of responsible person: , Date. C� (OVER) / Septic System Inspections: A-. All- applications .for septic system installation, alteration or repair, as required by the Town of Queensbury Sanitary Sewage Ordinance, shall be submitted to the Building Department at least 24 hours before start of construction and shall include a plot plan showing: 1.) the proposed location of the system 2.) location and distance to lot lines 3.) location and distance to structures 4.) location and distance to any water supply 5.) size and dimensions of all tanks, distribution boxes, tile fields and/or drywells B. No system shall be covered before inspection and approval. by the Building Inspector. Failure to comply with this requirement may result in the uncovering of the system by the installer and a fine of up to $250.00. C. An approved copy of the plot plan shall be available on the construction site. Failure to produce said plot plan at time of inspection may result in an immediate work stoppage. D. Should unforeseen problems during construction prevent proper installa— tion, alteration or repair of an approved system, a new proposal must be submitted to the Queensbury Building Department before further construction. Town of Queensbury BUILDING and CODES DEPARTMENT Bay and Haviland Roads Queensbury, New York 12804 Remarks: , /J NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPLICATION FORM "D" FOR A STATE-POLLUTANT DISCHARGE ELIMINATION SYSTEM (SPDES) PERMIT (Becomes A SPDES Permit When Signed By. Permit Issu-i ng Official) LEASE PRINT OR TYPE) r. S I I f1 O n 'PLICATI N TYPE IF RENEWAL OR MODIFICATION,GIVE PREVIOUS NO. v U (51 New [-]Renewal [:]Modification N Y — c.4 -J 'T 1983 VNEWS NAME(Corporate, Partnership or Individual) TYPE OF OWNERSHIP ENOCH & PATRICIA ZYLOWSKI . ❑Corporate ] Individual; E7, j&Q- shy ❑ Public VNER'S MAILING ADDRESS(Street, City, State, Zip Code) Vl 1R BURG, j 2353. Jade Lane, Schenectady, New York 12309 FER ALL CORRESPONDENCE TO: (Name,Title and Address) TELEPHONE NO.(laclude Area Code) e c. lol rer r- to, [ Cot-Mct. • 518 370-0897 iCILITY NAME FACILITY LOCATION(Street or Road) CITY,TOWN-OR VILLAGE BELLEWOOD' PARK SUBDIVISION' Bay Pky. , Assembly Pt. Queensbury )UNTY GIVE EXPLICIT DIRECTIONS TO LOCATION, IF NECESSARY Warren E. shore Assembly Point, l mile North. of Route. 9L �TURE OF BUSINESS OR TYPE OF FACILITY POPULATION SERVED(See Instructions) Residential Subdivision.- 12 lots EQUENCY OF DISCHARGE All Year? t4 Yes ❑No If"No",Specify No. of'Months All Week? ❑Yes ❑No If"No", Specify No.of Days :)ES YOUR DISCHARGE CONTAIN OR IS IT POSSIBLE FOR YOUR DISCHARGE TO CONTAIN ONE OR MORE OF THE FOLLOWING SUBSTANCES ADDED AS A RESULT OF )UR OPERATIONS, ACTIVITIES OR PROCESSES? Please Check: ❑Aluminum. ' Ammonia ❑Beryllium ❑Cadmium ❑ Chlorine ❑Chromium -❑ Cupper ❑ Cyanide ❑Grease Q.Lead 0 Mercury O Nickel ❑Oil ❑Phenols ❑Selenium. O Zinc 0 None of These SCHARGE DATA(Use additional forms, If necessary)(See Instructions) 1TFALL NO. IN Proposed ❑Replacement TYPE OF WASTE TYPE OF TREATMENT Septic Tank DESIGN FLOW 1 ❑Existing ❑Expansion Sanitary_ & Absorption Bed 5400 Gal/Dal iRFACE DISCHARGE I I "Yes",Name of Receiving Waters (Classification(Waters Index No., ❑Yes ❑ No iBSURFACE DISCHARGE If"Yes",Name of nearest Surface Water Distance SOIL TYPE Depth to Water Tabl (� Yes ❑No LACE 6a0ee7� 4eo Ft. IVIED. 7'o F01AJe 3.7IA;65 $ )TFALL NO. O Proposed ❑Replacement TYPE OF WASTE TYPE OF TREATMENT DESIGN FLOW ❑Existing ❑Expansion Gal/Dal RFACE DISCHARGE I'if"Yes",Name of Receiving Waters (Classification(Waters Index No. ❑Yes ❑No dSURFACE DISCHARGE If"Yes",Name of nearest Surface Water Distance.. SOIL TYPE Depth to Water Tabl ❑Yes ❑No Ft. JTFALL NO.1❑Proposed ❑Replacement TYPE OF WASTE TYPE OF TREATMENT DESIGN FLOW ❑Existing ❑Expansion Gal/Dal RFACE DISCHARGE I If"Yes",Name of Receiving Waters (Classification(Waters Index No.. ❑Yes ❑No BSURFACE DISCHARGE If"Yes",Name of nearest•Surface Water Distance SOIL TYPE Depth to Water Tabl ❑Yes ❑No I I Ft. I I hereby affirm under penalty of perjury that information provided on this form and any attached supplemental forms is true to the best of my knowledge and belief. Ilse statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law. 'PLICANT'S SIGNATURE(See Instructions) Date Printed Name Title p 9- Z z- V3 Enoch Zylowski , Owner PERMIT VALIDATION SECTION APPLICATION NO. (Department of Environmental Conservation Use Only) NY— 013 171+ This SPDES permit is issued in compliance with Title 8 of Article 17 of the Environmental EFFECTIVE DATE EXPIRATION DATE ;.-crvation Law of New York State and in compliance with the provisions of the Federal Water utiun 'control AGt, as amended by the Federal Water Pollution Control Act Amendments of. ATTACHMENTS': 12. P.L. 92-500, October 18, 1972 (33 U.S,C. §1251 et. seq.) (hereinafter referred to as "the ��N ��DIT►��S and spbbject to the attar ed conditions. A Lin Signature of Permit I suing Official I Date ARD Type Type SIC Code I Out Dis CARD Region County Major Sub Compact CARD Latitude Longlitude CARD Lim Ind Est Own Falls Class Basin Basin Area 66 68 70 73 74 76 I 3 715 (� 6 z 14 /) J 78 6 S3 S8 9 64 7 57 -19-1 (8/77) ✓ �O 1 (COPYSTATE OF NEW YO R K DEPARTMENT OF HEALTH `'' OFFICE OF PUBLIC HEALTH DISTRICT OFFICE • 21 BAY STREET • GLENS FALLS, N.Y. 12801 • TEL. (518) 793.3893 ❑AVID AXELROD, M.D. Ian T. Louclon, M.D. ; D.P.H. )akkj1R'X�i kk3� AXWX3(A Commissioner regional }:ealth Director myf"Ox Northern Region Brian S. Fear, P.E. District Director December- 21 , 1984 -ff4 Mr. & Mrs. Enoch Zylowski Bellewood Park 2353, Jade Lane Schenectady, New York 12309 Dear Mr. & Mrs . Zylowski : Plans consisting of one tracing and three paper prints along with the necessary supporting information for this subdivision have been reviewed. The project is satisfactory and the Certificate of Approval is enclosed. If any changes are required by the local governing agency or any other agency having jurisdiction after this final Health Department approval is granted, the revised final plan must be reapproved by the State Health Department. With the exception of one paper print which we have retained for our files, the approved plans were returned to your engineer/surveyor. Very truly yours, Brian S. Fear, P .E. District Health Director Enclosure BSF:ns / cc: Coulter & McCormack, L.S..✓ COPY SUBDIVISION REVIEW PLANNING BOARD TOWN OF QUEENSBURY Richard Roberts, Chairman Ronald S. Montesi , Secretary R. D. #1, : Haviland Road 18 Meadow Drive Glens Falls, New York Glens Falls, New .York. TO: Andrew T- McCormaack RE: Pellewood Park Sub. fl-82 Coulter and McCormack Fnoch and Patricia Zylowski, L1eu ol�nAY 92 Bay Street 12 Lots Assembly Point ATTN: Glens Falls, New York DATE: Feb. 1, 1984 GENTLEMEN: Please be advised that we have reviewed the above subdivision and the following action has been taken: (X ) Final Approval Granted ( ) Preliminary Approval Granted ( ) Rejected 1. For further action we need the following: ( ) State Health Department Approval ( ) Town Highway Superintendent Approval ( ) Town Water Superintendent Approval ( ) Other Please furnish necessary data and prints to the agencies for their re- view and comments. Submit copies of your plans for our use. REMARKS: Very truly yours, PLANNING BOARD CC: Adirondack Park Agency Project 82-12 yy A' -F-; New York State Department of.Environmental ,Conservation. <. Regulatory Affairs Box 220 Warrensburg, New York 12885 Telephone: (518)62.3-3671 .or 668-5441 Henry G.Williams Commissioner' January 11,:,1984 Enoch & Patricia "Zyl ows ki. . " 2353 Jade Lane Schenectady, .NY 12309 Re: U.P.P..' Number. 50-83-0202 Program ID No.:NY-013-1741: . Dear'Sir: Enclosed .is your SPDES (State Pollutant Discha.rge. :Elimination System) perm.i t' with attachments.', ' If you have. any' technical questions: concerning this permit, please. direct them to Environmental Quality Unit at..Warre=nburg, telephone: (518)623-36710 :Si.ncere;ly,:. Thomas W Hal l , Alternate Regional'. Permit. : Administrator: . . TWH/n.. . Encl: _ THE NEW YORK BOARD OF FIRE UNDERWRITERS F-L!7 03 7284 BUREAU OF ELECTRICITY 41 STATE STREET,ALBANY,NEW YORK 12207 Date ( .''TOBER 26- v 1990 'Application No.on file 05674890/90 Ll 0411839 THIS CERTIFIES THAT 1 only the electrical equipment as described below and introduced by the applicant named on the above application number in the prernisea of L7-� 77 55 j 77 ��•• 7 T•� q y t -. }f� {r 7 r 7 q 7 F r•�;7 r ` it }CII 7i L01 f,i e LAV I';1117:1+ S :i�? .��tjl.l�..•? 3�1,7.1-:\�,S . "DC!.E:.�f:.�'4:iJl��.RJ . N• 1 in the following location; C Basement '1sst Ft. LJ 2nd Ft. t)f i Section Block Lot was examined on c-j f E , ��t'C and found to be in compliance with the requirements o this Board. c��. ��r ��, �.�.r ,_t � f p q f FIXTURE KEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. 1 K.W. AMT. K.W. AMT. K.W. AMT. H.P. 3 z 3 41 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL RECTT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT. I K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H P SYSTEMS AMT WATTS a NO.OF FEET SERVICE DISCONNECT NO.OF S E R- V 1 C E AMT. AMP. TYPE METER �,YW �.3W 3 3W 3.8'IW NO.OF CC COND. A.W.G. NO. HI-LEG --- A=W G• NO A.NEUTRALS A.W.G. EQUIP. PER B OF CC.COND.. OF HI OF NEUTRAL OTHER APPARATUS: \ Pill BOX - BRANCH MANAGER f !-i Per This certificate must not be altered in any manner;return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS C F CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. h// TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT 531 BAY ROAD QUEENSBURY, NEW YORK 12804 TELEPHONE (518) 745-4447 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED_ NAME LOCATION � ,i � ,clJZLcI DATE X/ L PERMIT f TYPE OF STRUCTURE ,Q �; p����� �� RECHECK APPROVED N/A YESI NO FOOTINGS/PIERS MONOLITHIC POUR FORM REINFORCEMENT IN PLACE THE CONTRACTOR IS RESPONSIBLE FOR PROVIDING PROTECTION FROM FREEZING FOR 48 HOURS FOLLOWING THE PLACEMENT OF THE CONCRETE. MATERIALS FOR THIS PURPOSE ON SITE FOUNDATION/WALL POUR REINFORCEMENT IN PLACE FOUNDATION/DAMPROOFING BACKFILL APPROVAL ROUGH PLUMBING PLUMBING VENT/VENTS IN PLACE PLUMBING UNDER SLAB FRAMING: JACK STUDS/HEADERS l BRACING/BRIDGING JOIST HANGERS JACK POSTS/MAIN BEAM HEATING ROUGH-IN INSULATION: #u FOUNDATION WALLS INTERIOR'R- FOUNDATION WALLS EXTERIOR R- FLOORS , R- WALLS ,W R- CEILING R- DUCT WORK OR PIPING IN, UNHEATED SPACES f' .t" REMARKS: ARRIVE b 2j ,DEPART &Zo ev- 'MsPECTOR own o f QueenAury' BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION r NAME LOCATION DATE PERMIT,'NO. Jof 17 f ' SOIL TYPE '- Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation; rate - Min/Inch �f TYPE of SYSTEM: Absorption field, total length Length of each trench ' Depth of trenches Size of gravel K SEEPAGE PITStNumber of) Size- ft. X _ ; ft. Gravel size PIPING: 1 ; Size Type Bldg. to tank Tank to dist. box Dist. box to f did/pit Openings sealed:? YES NO Partial 41. LOCATION/SEPARAT2ONS: Foundation to tank ft. Foundation to "absorption ft. Absorption to lot;;, line ft. Separation of" pits ft. LOCATION OF SYSTEM ON PROPERTY(circle one) Front - Rearj- Left side - Right side - COMMENTS: s ' T 71 s, , 7 SYSTEM USE APPROVED YE NO 4 s, V Bui1 ing`JInspector 01/86 and vl _/ouln o/ QueenAury BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME, LOCA%�tJl6 DATE / O PERMIT NO. �1 � SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field, total length Gd�az� Length of each trench gp ; Depth of trenches ' Size of gravel' a. _ SEEPAGE PITS4Number of) Size- ft. X _ ft. Gravel size PIPING: Size Type Bldg. to tank Tank to dist. box C2,- , -3�•-o?ZC� Dist. box to field/pit - '�= -WR-01-6 Openings sealed? YES Y40 Partial LOCATION/SEPARATIONS: Foundation to tank , ft. Foundation to absorption °,,ft. Absorption to lot line 'ft. Separation of pits ft. LOCATION OF SYSTEM ON PRrOPERTY(O rcle one) Front - Rear - Left side - Right1side COMMENTS: re SYSTEM USE APPROVEAding Bector 01/86 and vl TOWN OF QUEENSBURY BUILDING AND CODES DEPARTMENT BAY & HAVILAND ROADS QUEENSBURY, NEW YORK 12804- TELEPHONE (518) 792-5832 BUILDING INSPECTOR'S REPORT REQUEST FOR INSPECTION RECEIVED NAME LOCATION Gr/'✓.. DATE ( < PERMIT # �{ C} APPROVED YES NO FOOTING/PIERS / MONOLITHIC POUR FORMS,. / FOUNDATION/DAMP-PROOFING BACKFILL APPROVAL /I ROUGH PLUMBING J FRAMING ELECTRICAL ROUGH-IN INSULATION: J FOUNDATION r ,� FLOORS WALLS CEILING FINAL INSPECTION: CHIMNEY HEIGHT ROOFING SIDING EXTERNAL PORCHES/STEPS STAIRS-CLEARANCE & RAILS PLUMBING FIXTURES/RELIEF VALVE INTERIOR TRIM/PRIVACY DOORS , FINISHED FLOORS GARAGE FIREPROOFING DOOR CLOSER(S) SMOKE DETECTORS FINAL ELECTRICAL INSPECTION FINAL APPROVAL OF CONSTRUCTION A SIGNED CERTIFICATE OF OCCUPANCY MUST BE OBTAINED FROM THE BUILDING DEPARTMENT BEFORE THESE PREMISES ARE OCCUPIED!-. REMARKS: %© j INSPECTOR - cc�� 310 _/own o f QuerniLry 37� BUILDING and ZONING DEPARTMENT Bay and Haviland Road, R.D. 1 Box 98 Queensbury, New York 12801 SEPTIC DISPOSAL SYSTEM INSPECTION NAME LOCATION F , DATE /1I1 / PERMIT NO.he P- if,-3 SOIL TYPE - Sand - Loam - Clay - Percolation Test Required? YES - NO Percolation rate - Min/Inch TYPE of SYSTEM: Absorption field, total length Length of each trench Depth of trenches ' Size of (jravel_ SEEPAGE ]SITS{Number of) Size- ft. X _ ft. Gravel size PIPING: Size Type Bldg. to tank Tank to (list. box Dist. boy: to field/pit Openings sealed? YES NO. Partial LOCATION/SEPARATIONS: Foundation to tank 1''" ft. Foundation to absorption ft. Absorption to lot' line ft.: Separation of pits ft. `. LOCATION OF SYSTEM ON PROPERTY(circle one) Front - Rear - ,eft side - Right side - COMMENTS: t SYSTEM USE APPROVED YES Building Inspector 01/86 and vl